[Delineating Concept for Defining the Country Practitioner - - An Objective Approach for Implementation in the Field...

In the context of the scientific discussions on health care research, a concrete and uniform definition of a country practitioner is still lacking. This would be essential, however, for the future design of the medical care structure in Germany. In particular, the ongoing discussions on the predicted shortage of physicians in rural and mostly economically undeveloped regions - a shortage that is already affecting parts of Germany - suggest the need for clarification of the concept of a country practitioner. Only on the basis of a uniform definition does it seem possible to develop and discuss effective solutions across regions and to be able to use them in a targeted manner. The multitude of existing approaches to solutions, which include, among others, telemedicine, health centres, community nurses, outpatient care services being undertaken by hospitals, and youth development, must be evaluated and adapted to actual needs. The article presents a newly developed multi-stage plan for the differentiation between rural and urban doctors, which enables the definition of "country practitioner" to be adapted according to the region. With the aid of the definition, a review and further development of the aforementioned approaches to solutions can take place. Moreover, by applying the concept of delineation, there is an opportunity to create completely new ideas and solutions in the context of health services research. The basis of the new approach to rural and urban medical delineation essentially consists of the following delineation steps: basic centre (Step I), rural settlement (Step II) and central geographic location (Step III). In the following, these 3 successive delineation steps are first separately and theoretically derived. Thereafter, the presented concept is applied to the region of Westphalia-Lippe. The developed model collectively offers a standardized approach that is feasible from a temporal and financial perspective. The primary aim of this paper is to contribute to the ongoing discussion on outpatient care research and, in particular, to the definition of the country practitioner. Using the model approach presented here, this definition also enables comparisons to be made between different regions of Germany.